Could HRT Be the Best Treatment for Menopause Headaches?

Published August 8, 2019

There’s a sharp, persistent throb on the side of your head, a pulse of pain that seems to quicken even while it slows down time. You have trouble concentrating, become acutely sensitive to noise and lights, feel nauseous, and maybe even experience vomiting. It’s a migraine. And if you are undergoing menopause, it could be the result of your changing hormones.

It is well known that migraines often increase in both frequency and severity during the menopausal transition, resulting in physical pain and, often, functional disruption. While these headaches aren’t the most famous symptoms of menopause, for many women they are among the most debilitating. If you are approaching menopause, taking steps to avoid migraines can help you feel your best through this pivotal stage of life. Now, a growing number of practitioners believe that hormone replacement therapy (HRT) could be the best treatment for menopause headaches for some women.

The Relationship Between Hormones and Headaches

Many within the medical community used to believe that headaches increased during perimenopause but decreased in menopause. However, a 2018 paper published in Current Treatment Options in Neurology, explored the link between headaches and hormones and found that the relationship is far more complex—and deeply individual. While headaches improved for about 25% of menopausal women, they were actually worse for 35.7%. Overall, up to 30% of women report higher incidence of migraines during perimenopause or menopause than before. Another 2018 study found that among women with a history of migraines, 60% experience a change in their migraine patterns and for 60% of those women, the change is for the worse.

Why does this occur? It is thought to be primarily driven by the decline of estrogen as well as, potentially, the drop in progesterone. These hormones impact critical functions throughout the body, including vasomotor and neuronal activity, which may help explain why women are nearly three times more likely than men to experience migraines. Additionally, sex hormones impact neurotransmitter activity, which is believed to play a critical role in migraine pain. As noted by researchers in the International Journal of Women’s Health, “Estrogen is associated with increased production of serotonin, reduced serotonin reuptake, and decreased serotonin degradation,” all of which may impact the development of menopause headaches. However, the fact that only some women experience an increase in migraine frequency and severity in perimenopause and menopause while others experience the opposite suggests that many factors are likely at play, including other physiological phenomena and environmental variables.

Common Strategies for Preventing or Treating Menopause Headaches

The exact relationship between migraines and menopause is still under investigation and may be more fully clarified by future research. However, we do know that there are meaningful steps you can take to minimize the occurrence of menopause headaches and alleviate your discomfort when they do happen.

Avoiding Migraines

Medication. There are many medicines that have been shown to prevent or minimize the frequency of migraines, including a variety of antidepressants, anti-seizure medications, beta blockers, calcium channel blockers, and CGRP inhibitors. Of course, it goes without saying that none of these should be used without consulting your physician.

Regular sleep. Sleep, mood, and headaches are controlled in the same regions of the brain by the same chemicals. While regular, healthy sleep patterns keep your brain in balance, lack of sleep, irregular sleep, poor quality sleep, and even oversleeping can be migraine triggers.

Track your dietary triggers. There’s no doubt that diet can cause migraines. Tracking what you eat and looking for a relationship with your headaches can help you identify any trigger foods and avoid them.

Acupuncture. While not all studies on the efficacy of acupuncture have shown clear benefits, a 2017 study published in JAMA Internal Medicine found that “among patients with migraine without aura, true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list.”

Relieving Migraine Pain

Relaxation. Research shows that massages, meditation, deep breathing, yoga, and other mind-body practices aimed at relaxation can help to lessen the pain and improve other symptoms of a migraine.

Over-the-counter medications. Normal pain relievers such as ibuprofen, aspirin, acetaminophen, and naproxen are effective for many people, although largely as a masker of symptoms.

Triptans. Triptans are a family of drugs that have been used to treat migraine symptoms since the 1990s. These medications, which include Imitrex and Maxalt, are highly effective for many patients, but do not prevent migraines from occurring. Some patients also experience side effects such as dizziness, nausea, or muscle weakness.

While these strategies can provide significant relief for many, in recent years there has been a growing interest in addressing the root of menopause headaches themselves: hormones.

Could HRT Be the Best Treatment for Menopause Headaches?

Hormone replacement therapy has been used for decades to help replenish the estrogen and progesterone that fall with age. In doing so, many women find significant relief from well-known menopause symptoms such as hot flashes, night sweats, and mood swings. However, it may be possible to deploy HRT as a way to prevent the occurrence of menopause headaches.

For some women, HRT is associated with an aggravation of migraines, particularly if taken orally. However, the impact of both menopause and HRT on headaches is variable and deeply individual, and the fact that HRT is an aggravating factor for some women does not preclude other women from benefiting. Additionally, the idea of using HRT as a protective measure against migraine is still developing. As such, there are no guidelines on how to use it in this way and existing studies have not investigated the impact of HRT used with migraine prevention as a goal.

But a growing number of practitioners are seeing the potential. At the annual meeting of the American Headache Society last year, Dr. Yu-Chen Cheng, a neurologist and postdoctoral fellow at Massachusetts General Hospital and Harvard Medical school, emphasized that she and many of her colleagues do see evidence of HRT’s protective effect against migraines in the clinical setting. This means that HRT, unlike other treatments, could be used to not simply mask symptoms, but change the very conditions in which migraines develop. For many women, this could be life-changing.

If you are interested in trying HRT to alleviate your menopause headaches, start by connecting with a practitioner who specializes in hormone health and has the expertise necessary to deliver customized care. They can perform comprehensive hormone level testing, which includes running tests on blood, saliva, and urine. An analysis of those lab results is incorporated with analysis of your family history, your medical history, your lifestyle, symptoms, and more. With a full picture of your needs in place, they can create a personalized treatment plan designed to address your menopause symptoms, potentially including your headaches.

Chances are, you don’t want to mask the pain. You don’t want to just cope with the nausea or light sensitivity. You want to stop those things from occurring in the first place. And with the right hormone replacement therapy, it may be possible.

The practitioners in theBodyLogicMD network are leading experts in integrative medicine and hormone health. If you’re ready to take control of your menopause symptoms and your overall health, BodyLogicMD-affiliated practitioners can help you set meaningful goals and create a personalized treatment plan to you achieve them. Contact a local practitioner in your area to start your journey toward optimal health, or take the BodyLogicMD Hormone Balance Quiz to learn more about how hormones may be impacting your everyday life.

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.

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Dr. Wharton is truly dedicated to his work and cares about his patient's wellbeing. He continually reads current research and applies new knowledge to his practice. He has improved my life dramatically and has erased many, many horrible symptoms of menopause. I value his input and hold him in very high regard, and I am sure you will too! TC…Read More

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Dr. Wharton: I wanted to thank you for introducing me to your Bodylogic practice. I am 47 years old, and I believe I have been suffering with perimenopause for the last seven or so years. I also have thyroid problems, coupled with chronic migraines that would last for days at a time. To sum it up most days I felt…Read More

I have been having hot flashes for 14 years, and I was so frustrated after trying many of the over-the-counter supplements with absolutely no relief. Dr. Wharton ran a battery of tests, some of which I have never had before, and from those results he prescribed a bio-identical estrogen/progesterone cream, along with a testosterone pellet. The change I felt was amazingly different than…Read More